If you are lucky it is virtually invisible, if not it can be pretty darn ugly, and that is just on the surface. When you start delving down you find more of it, and at this point invisibility isn’t such a blessing, and the impact of it can be more profound than you would think. What is this? It’s scar tissue. That’s right, the thick, not too sensitive, sometimes pink or red result of all injury to our bodies. This stuff is pervasive and occurs throughout our bodies, often in places we would not imagine.

So the first thing to do is define what scar tissue is, and, perhaps more importantly, why it is. Scar tissue is the fibrous, collagen rich, elastin poor granulose tissue that your body uses to repair soft tissue (muscle, tendon, ligament, and fascia) injury within your body. Almost anytime inflammation occurs in the body so does scar tissue. With more profound injury and in cases where there is tissue loss the scar tissue can be quite extensive, which of course makes its impact that much more significant. The why of scar tissue is that your body is trying to piece back together tissue that has been ruptured or to reinforce tissue that it believes is not strong enough. Basically this is the duct tape of your body, and just like duct tape it is darn handy and is an essential part of your bodies self-repairing system.

Now that is all very positive, so why was I maligning it in my last article, and why have I been dropping portentous hints in this one? Well, have you ever used too much duct tape? It makes a bit of a mess, can prevent something that should move from doing so and, if it is laid down incorrectly it can stick other things to it and that leads to even more problems. This is exactly the problem with scar tissue. Too often it is laid down randomly in the body and you end up with a scar that is larger than it needs to be, that is sticky, disorganized and dysfunctional. The other complication with both duct tape and scar tissue is if you lay down this stiff, not very stretchy material in the middle of some mobile, active material it becomes a stress point, a place where you actually have more chance of the original fabric becoming damaged. And if it happens to sticks together two stretchy things that want to stretch in different direction you are guaranteed to lose some of the original movement and to do constant, minor damage. To have little, tiny tears in the fabric happen every time you move. Now in a t-shirt that will ultimately mean the duct tape pulls off, or you get a hole or a tear in the nearby fabric, not great for the t-shirt. Now imagine that process within your body. Two muscles stuck together by scarring, every time you move small tears in the muscle fibre, a bit of inflammation, a bit more scar tissue, a bit less freedom of movement, a bit more tearing….eventually you get a rupture, here the duct tape analogy falters, for the scar tissue will not be what ruptures, it is too strong and too well enmeshed in your muscle, you will always end up with another muscular rupture adjacent to the scarring. The process then begins again. This is one of the reasons someone will have a recurrent injury. Sprained and strained ankles being an ideal example, with ankle injury you often see a mild to moderate strain or sprain followed by a series or minor irritation that the person bandages and works/plays through, and then another serious incident, and this time, even if the incident is only of the same intensity the injury will be greater, because the area is compromised. That is the great downside of scar tissue, it compromises our tissue.

Now, on the bright side this is a process that can be modified. Through proper rehabilitation treatment and exercises scar tissue development can be made more functional and less compromising. Both machine based (i.e. ultrasound) and manually applied (i.e. frictioning) techniques can help ensure that your scar tissue is laid down in a tidy manner that improves its functionality and surrounding tissue can be prevented from sticking or be released if it becomes adhered. These applications minimize the subsequent issues that I discussed in the previous paragraphs and can greatly reduce the chance of re-injury.

Cosmetically this also reduces the visibility of the scar. There are two aspects to this. One, the scar is smaller and there is less likelihood of the scar becoming keloid (a keloid scar is one that overgrows the perimeter of the original injury, is raised and discoloured). Two, the adhering of adjacent tissue that often occurs with untreated scars, especially ones of significant size or severity, creates lines of pull in the skin. If you have every seen puckering, or indentations around or over a scar that is the result I am describing. These lines can become very entrenched and distort your skin. The other, less cosmetic issue can be discomfort. It is this second development is the one that can lead to that pulling, overstretched feeling that you may have experienced if you have scars of any significance.

My next posting will touch on a seasonally relevant issue, the flu shot. Good, bad, ugly? What is your best course of action?